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High Blood Pressure Treatment Guidelines

Topic Overview

Doctors have more than one set of guidelines they can follow for treatment of high blood pressure.1, 2, 3, 4, 5, 6

The guidelines are based on research evidence and expert opinion, and their recommendations differ in slight ways. But the goal of treatment is the same: to lower your risk of health problems that are caused by, or made worse by, high blood pressure.

If you have high blood pressure, you'll work with your doctor to lower it. Your doctor uses a guideline to help make a treatment plan that is right for you. No matter which guideline your doctor uses, your treatment plan can help you lower blood pressure and stay healthy.

Blood pressure classification

An ideal blood pressure for adults is less than 120/80. High blood pressure is 140/90 or higher.2

Blood pressure classification

If the first (systolic) number is:

OR the second (diastolic) number is:

Your blood pressure is:

120 to 139

80 to 89

Borderline-high (prehypertension)

140 to 159

90 to 99

High

160 or more

100 or more

Very high

Blood pressure goals

Your doctor will give you a blood pressure goal. You'll want to try to keep your blood pressure below your goal. Your goal is based on your age and health. Treatment guidelines differ slightly about blood pressure goals for certain groups of people. No matter which guideline your doctor uses, he or she will recommend a goal that is right for you.

If you have a health problem such as diabetes, heart disease, or kidney disease, your goal might be less than 140/90.

If you don't have another health problem, your goal might be based on your age. For example, if you are over 60, your goal might be less than 150/90.

Treatment options

Your options depend on how high
your blood pressure is, whether you have other health problems such as
diabetes, and whether any organs have already been damaged. Your doctor may also consider how likely you are to develop other diseases, especially heart
disease.

Treatment options

Blood pressure

Treatment

Prehypertension (120–139 over 80–89)

Lifestyle changes

High blood pressure (140–159 over 90–99)

Lifestyle changes, possibly
medicine

Very high blood pressure (160 over 100 or
higher)

Medicine plus lifestyle
changes

Everyone needs to have a healthy lifestyle, no matter what his or her blood pressure goal is. Lifestyle changes are as important as medicine in lowering blood pressure and lowering the risk for heart attack and stroke. Lifestyle changes include losing weight, eating healthy, being active, limiting sodium and alcohol, and not smoking.

If healthy habits aren't enough to bring your blood pressure down to your goal, you may need to take medicine too. Work with your doctor to decide what is right for you.

Guidelines for children

Children who have
high blood pressure often continue to have high blood
pressure as adults. Children ages 3 and older may have their blood pressure
monitored regularly during routine physical exams.7

High blood
pressure in children is rare but needs to be evaluated to find treatable
causes. When a child has high blood pressure, it is more likely to be from a
secondary cause—like a disease—than when an adult has high blood
pressure.

High blood pressure in children should be treated with
lifestyle changes. A child might take medicine too, if needed.8, 9

Related Information

References

Citations

James PA, et al. (2013). 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association. DOI: 10.1001/jama.2013.284427. Accessed December 18, 2013.

Go AS, et al. (2013). An effective approach to high blood pressure control: A scientific advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. DOI: 10.1161/HYP.0000000000000003. Accessed December 30, 2013.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

U.S. Preventive Services Task Force (2013). Screening for primary hypertension in children and adolescents. http://www.uspreventiveservicestaskforce.org/uspstf/uspshypechld.htm. Accessed January 11, 2014.

Falkner B, Daniels SR (2004). Summary of the fourth
report on the diagnosis, evaluation, and treatment of high blood pressure in
children and adolescents. Hypertension, 44(4):
387–388.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.

James PA, et al. (2013). 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association. DOI: 10.1001/jama.2013.284427. Accessed December 18, 2013.

Go AS, et al. (2013). An effective approach to high blood pressure control: A scientific advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. DOI: 10.1161/HYP.0000000000000003. Accessed December 30, 2013.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

U.S. Preventive Services Task Force (2013). Screening for primary hypertension in children and adolescents. http://www.uspreventiveservicestaskforce.org/uspstf/uspshypechld.htm. Accessed January 11, 2014.

Falkner B, Daniels SR (2004). Summary of the fourth
report on the diagnosis, evaluation, and treatment of high blood pressure in
children and adolescents. Hypertension, 44(4):
387–388.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.

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